Utilization Management Specialist I: Care Coordination

SUN Delaware; Georgetown (DE); On-site; USD 55,000 - 75,000; Full time

Job summary

SUN Delaware in Georgetown, DE is seeking a Health Care Case Manager to coordinate case management from pre-hospitalization through discharge and assist with admissions authorizations for hospital stays.

The role involves processing retroactive reviews, communicating with insurance providers, and participating in quality and safety initiatives. A high school diploma or GED is required, with CPR and de-escalation certification preferred; 1 year in behavioral health is expected.

Qualifications

• High school diploma or GED required; CPR and hospital-selected de-escalation certification.
• One year of experience in a behavioral healthcare setting.
• Preferred: Associate's or Bachelor's degree; Experience in Utilization Management or as a Mental Health Tech.

Responsibilities

• Coordinate case management and assist with admissions authorization.
• Process retroactive reviews and appeals; document and write letters to insurers.
• Communicate with Physicians, Nurse Practitioners, Clinical Services, Nursing and Referrals to ensure coverage.
• Attend staff meetings and participate in performance improvement activities.
• Maintain documentation and ensure HIPAA/privacy compliance.

Education

High School Diploma or GED

Associates or Bachelors degree

Tools

CPR certification

De-escalation technique certification

Job description

SUN Delaware in Georgetown, DE is seeking a Health Care Case Manager to coordinate case management from pre-hospitalization through discharge and assist with admissions authorizations for hospital stays.

The role involves processing retroactive reviews, communicating with insurance providers, and participating in quality and safety initiatives. A high school diploma or GED is required, with CPR and de-escalation certification preferred; 1 year in behavioral health is expected.